Journal of Current Glaucoma Practice

Register      Login

VOLUME 13 , ISSUE 2 ( May-August, 2019 ) > List of Articles


Migration of XEN45 Implant: Findings, Mechanism, and Management

Zaria C Ali, Dawnn I Khoo, Francessco Stringa, Vikas Shankar

Keywords : Complications, Minimally invasive procedure, Surgical treatment, XEN

Citation Information : Ali ZC, Khoo DI, Stringa F, Shankar V. Migration of XEN45 Implant: Findings, Mechanism, and Management. J Curr Glaucoma Pract 2019; 13 (2):79-81.

DOI: 10.5005/jp-journals-10078-1253

License: CC BY-NC 4.0

Published Online: 01-04-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The aim of this study is to report the mechanism of XEN migration and its management. Background: Over the past decade, new less invasive surgical approaches for glaucoma have been devised and carried out successfully. One such technique is the use of the XEN gel stent. We present a rare and relatively unknown complication of XEN migration and present in detail the likely mechanism by which this occurs, and its subsequent management. Case description: A 73-year-old male with primary angle closure on maximal medical treatment presented with an intraocular pressure of 30 mm Hg in the left eye. The visual acuity was 6/5, iridocorneal angles were open in all four quadrants, and the cup disc ratio was 0.4. As phacoemulsification alone was unlikely to adequately lower intraocular pressures, the patient underwent combined phacoemulsification and XEN implantation. Although the patient had a good postoperative result with pressures lowered to 11 mm Hg, 4 months after the operation, the XEN was found to have migrated 4 mm into the anterior chamber, associated with a low-grade uveitis. The patient subsequently had the XEN explanted a new XEN inserted. Pressures lowered 1 month postoperatively to 14 mm Hg. Conclusion: XEN migration is likely due to a combination of mechanical and frictional forces. If the XEN is positioned such that more than 2 mm is in the subconjunctival space, the XEN is likely to be angled upward and, therefore, be more susceptible to these forces and undergo migration. Clinical significance: It is essential that XEN implants are correctly sited and that this is confirmed intraoperatively to prevent the need for further procedures.

  1. De Gregorio A, Pedrotti E, et al. XEN glaucoma treatment system in the management of refractory glaucomas: a short review on trial data and potential role in clinical practice. Clin Ophthalmol 2018;12:773–782. DOI: 10.2147/OPTH.S146919.
  2. Grover DS, Flynn WJ, et al. Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months. Am J Ophthalmol 2017;183:25–36. DOI: 10.1016/j.ajo.2017.07.023.
  3. VAI Vera, Stalmans I, et al. Gel stent implantation—recommendations for preoperative assessment, surgical tecnique and postoperative managment. US Ophthalmic Review 2018;11(1):38–46. DOI: 10.17925/USOR.2018.11.1.38.
  4. Doane MG. Interactions of eyelids and tears in corneal wetting and the dynamics of the normal human eyeblink. Am J Ophthalmol 1980;89(4):507–516. DOI: 10.1016/0002-9394(80)90058-6.
  5. Cher I. Blink-related microtrauma: when the ocular surface harms itself. Clin Exp Ophthalmol 2003;31(3):183–190.
  6. Pult H, Riede-Pult BH, et al. The Relation Between Blinking and Conjunctival Folds and Dry Eye Symptoms. Optom Vis Sci 2013;90(10):1034–1039. DOI: 10.1097/OPX.0000000000000029.
  7. Leung EW, Medeiros FA, et al. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma 2008;17(5):350–355. DOI: 10.1097/IJG.0b013e31815c5f4f.
  8. Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg 2014;40(8): 1301–1306. DOI: 10.1016/j.jcrs.2014.01.032.
  9. Gillmann K, Bravetti GE, et al. Anterior Chamber XEN Gel Stent Movements: The Impact on Corneal Endothelial Cell Density. J Glaucoma 2019 Jun;28(6):e93–e95. DOI: 10.1097/IJG.0000000000001200.
  10. Atalay Kursat NSA. Kirgiz Ahmet. Complication of micro-bypass stenting: the anterior chamber displacement of a Xen implant. Arq Bras Oftalmol 2018;81(6):514–516. DOI: 10.5935/0004-2749.20180098.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.